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Onamia, MN, USA | Hourly | 20.61-30.92 per hour | Full Time

Summary

The Prior Authorization Specialist works under the direction of the Health Information Manager. This role ensures that payers are prepared to reimburse Mille Lacs Health System for scheduled services in accordance with payer-provider contracts. Responsibilities include requesting service authorizations, preparing, and submitting documentation, and managing appeals. The position requires strong communication, insurance knowledge, and the ability to work independently and collaboratively in a fast-paced healthcare environment.

Job Duties

The essential functions of this job are identified with an asterisk (*) at the end of the bullet point.

+ Receive and monitor prior authorization requests in accordance with MLHS standards. *

+ Review accuracy and completeness of documentation and ensure all supporting materials are present. *

+ Assist with medical necessity documentation to expedite approvals. *

+ Collaborate with departments and providers to obtain authorizations and support appeals. *

+ Write and submit appeals to insurance providers, including physician input when needed. *

+ Manage correspondence with insurance companies and document all interactions in the EMR. *

+ Record prior authorization details including approval dates, billing units, procedure codes, and authorization numbers. *

+ Review insurance denials and proactively submit appeals. *

+ Track and renew expiring authorizations. *

+ Work closely with other staff performing prior authorization functions. *

+ Secure patient demographics and medical information in compliance with HIPAA regulations. *

+ Complete all required duties, projects, and reports in a timely manner. *

+ Attend mandatory meetings and complete required training. *

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Employee will comply with all Mille Lacs Health System (MLHS) policies, including safety policies, procedures, and rules. All will be expected to report unsafe conditions to a member of management.

Required Education and Experience

+ Medical Assistant (MA) certification or Licensed Practical Nurse (LPN) licensure in the State of Minnesota

+ Minimum 1-2 years of prior authorization experience in a healthcare setting

+ Experience with medical terminology and insurance processes

+ Strong verbal and written communication skills

+ Proficient computer and business skills

+ Ability to manage multiple priorities and work independently or in a team

+ Knowledge of insurance eligibility and HIPAA compliance

Preferred Education and Experience

+ 5 years of prior authorization experience

+ 5 years of experience in a healthcare setting

Additional Eligibility Qualifications

+ Detail-oriented and self-directed

+ Ethical conduct and professionalism

+ Initiative and flexibility

+ Time management and stress management

+ Teamwork orientation and technical capacity

+ Quality and safety focused

Position Type/Expected Hours of Work

+ Full-time: 40 hours/week

+ Monday-Friday, 8:00 AM - 4:30 PM (training hours may vary)

+ No evenings or weekends

Supervisory Responsibility

None